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Health care for incarcerated youth

Position paper of the society for adolescent medicine

      Abstract

      cheryl
      Each year, increasing numbers of juveniles are incarcerated (
      • Costello J.C.
      • Jameson E.J.
      Legal and ethical duties of health care professionals to incarcerated children.
      ,

      Poe-Yamagata E. Detention and delinquency cases, 1985–1994. Office of Juvenile Justice and Delinquency Prevention fact sheet No. 56. March 1997. U.S. Department of Justice, Washington, DC.

      ). In 1991, 823,449 youths were detained in long- and short-term facilities in the United States (

      Austin J, Krisberg B, DeComo R. Juveniles taken into custody: Fiscal Year 1993. Office of Juvenile Justice and Delinquency Prevention. U.S. Department of Justice. Washington, DC; 1995:63.

      ). As the federal and state governments move to mandate harsher penalties for delinquent youth, this population is likely to increase (
      • Langan P.A.
      America’s soaring prison population.
      ). Systems that are already taxed will find their resources diminishing relative to demand. Many youth entering detention lack comprehensive health care and have long-term neglected health needs (

      Common Health Problems of Juveniles in Correctional Facilities. Chicago, IL: American Medical Association, 1979.

      ,

      Council on Scientific Affairs. Health status of detained and incarcerated youths. JAMA 1990;263:987–91.

      ), whereas the scope of the care offered by detention facilities varies widely.
      Juvenile detainees have been identified as a group that participates in high-risk behaviors including substance abuse (
      • Schneider J.
      The relationship between physical and sexual abuse and tobacco, alcohol, and illicit drug use among youths in a juvenile detention center.
      ,

      Survey of Youth in Custody, 1987. Special Report. Washington, DC: Bureau of Justice Statistics, 1988.

      ,
      • Jessor R.
      Risk behavior in adolescence A psychological framework for understanding and action.
      ,
      • Morris R.E.
      Health risk behavior survey from thirty-nine juvenile correctional facilities in the United States.
      ), early sexual activity (
      • Morris R.E.
      Health risk behavior survey from thirty-nine juvenile correctional facilities in the United States.
      ,
      • Litt I.F.
      • Cohen M.I.
      Prison, adolescents, and the right to quality medical care The time is now.
      ,
      • Hein K.
      • Cohen M.I.
      • Litt I.F.
      • et al.
      Juvenile detention Another boundary issue for physician.
      ,
      • Bell T.A.
      • Farrow J.A.
      • Stamm W.E.
      • et al.
      Sexually transmitted diseases in females in a juvenile detention center.
      ), violence (
      • Morris R.E.
      Health risk behavior survey from thirty-nine juvenile correctional facilities in the United States.
      ), weapon use (
      • Morris R.E.
      Health risk behavior survey from thirty-nine juvenile correctional facilities in the United States.
      ), murder (

      Statistical Abstract of the United States. The national data book. October 1997. Bureau of the Census, U.S. Department of Commerce, Economics, and Statistics Administration, 1997:209.

      ), and gang involvement (
      • Morris R.E.
      Health risk behavior survey from thirty-nine juvenile correctional facilities in the United States.
      ). This group also has a high prevalence of medical conditions including seizure disorders, respiratory disease, nutritional deficiencies, and orthopedic, skin, and dental problems (

      Common Health Problems of Juveniles in Correctional Facilities. Chicago, IL: American Medical Association, 1979.

      ,
      • Litt I.F.
      • Cohen M.I.
      Prison, adolescents, and the right to quality medical care The time is now.
      ,
      • Morris R.E.
      • Anderson M.
      • Baker C.J.
      Health care for incarcerated adolescents.
      ,

      Committee on Adolescence. Health care for children and adolescents in detention centers, jails, lock-ups, and other court-sponsored residential facilities. Pediatrics 1989;84:118–20.

      ,
      • Farrow J.
      Medical responsibility to incarcerated children.
      ,
      • Feinstein R.A.
      • Lampkin A.
      • Lorish C.D.
      Medical status of adolescents at time of admission to a juvenile detention center.
      ). In addition, juvenile detainees often have physical or psychological disorders that contribute to behavior problems (
      • Morris R.E.
      • Anderson M.
      • Baker C.J.
      Health care for incarcerated adolescents.
      ,
      • Hyde T.
      • Mitchell J.R.
      • Trupin E.
      ,
      • Owens J.W.M.
      Incarcerated youths Urgent needs.
      ,
      • Hollander H.E.
      • Turner F.D.
      Characteristics of incarcerated delinquents Relationships between development disorders, environmental and family factors, and patterns of offense and recidivism.
      ,
      • Lewis D.O.
      • Shanok S.S.
      • Pincus J.H.
      • Glaser G.H.
      Violent juvenile delinquents.
      ,
      • Lewis D.O.
      • Feldman M.
      • Barrengos A.
      Race, health, and delinquency.
      ). For example, a high rate of depression has been reported among detained youth (
      • Morris R.E.
      Health risk behavior survey from thirty-nine juvenile correctional facilities in the United States.
      ,
      • Feinstein R.A.
      • Lampkin A.
      • Lorish C.D.
      Medical status of adolescents at time of admission to a juvenile detention center.
      ,
      • Kashani J.H.
      • Manning G.W.
      • McKnew D.H.
      Depression among incarcerated delinquents.
      ). Moreover, during detention, youth may be at risk for accidental or self-inflicted injuries (

      Council on Scientific Affairs. Health status of detained and incarcerated youths. JAMA 1990;263:987–91.

      ,
      • Woolf A.
      • Funk S.G.
      Epidemiology of trauma in a population of incarcerated youth.
      ) as well as stress-related symptoms (
      • Farrow J.
      Medical responsibility to incarcerated children.
      ).
      The time in custody presents a unique opportunity to address the basic health concerns of this population and provide health education. However, a number of factors tend to impede the provision of excellent health care to detained adolescents. Currently, under federal regulations, incarcerated populations, even detainees under 18 years of age, are ineligible for Medicaid benefits. This prohibition postpones fulfillment of the health care needs of incarcerated youth.
      The provision of health care in detention settings is complex and multifaceted, and has the potential for conflicts of interest. The health care professional’s primary responsibility is to ensure the welfare of individual detainees. When youth already under psychiatric care are admitted to detention facilities, their care may be interrupted because of poor coordination between mental health providers within and outside the detention system. When juveniles are released from detention, follow-up of medical and psychological needs is often neglected. Incarcerated youth depend on others for their medical, psychiatric, and dental care, and lack outside oversight. Unfortunately, this situation can lead to a decline in accountability.
      The Society of Adolescent Medicine believes that health care providers in correctional settings should take an active role in ensuring the unimpeded access to health care for all juvenile detainees as well as the ongoing health and safety of the young people within their purview, and endorses the following positions:
      • Governmental agencies should provide adequate resources for appropriate health care within juvenile detention facilities. We believe that Medicaid coverage should continue for otherwise eligible incarcerated children and adolescents.
      • Medical and dental care must address emergent (life- or organ-threatening), acute (new onset), and chronic (pre-existing) conditions in youth. Each youth should receive health screening ideally upon arrival in detention or at least within 24 hours to rule out emergent needs, contagious diseases, and evaluation of the need to continue current medications. A complete health assessment and health maintenance examination should be offered within a few days of arrival (3–7 days) and include a medical and social history, physical examination, and assessment of immunization status and administration of the Centers for Disease Control and Prevention’s recommended immunizations as permitted by law. Sexually active females and all males should be screened for sexually transmitted infections. Appropriate follow-up and referral sources should be made available to facilitate continuing care as needed.
      • Mental health services must be available to provide timely care for acute and chronic psychiatric and emotional conditions including, but not limited to, acute psychiatric decompensation, depression and suicidality, and substance abuse.
      Although a trained mental health provider is the ideal care provider, other trained medical professionals may perform initial screening with appropriate referral for those detained youth who require additional assessment and treatment. A critical focus of mental health screening should be suicide risk and requires the implementation of appropriate precautions should sufficient risk be present. Finally, many youth who enter detention may be taking psychotropic medication. Mechanisms to continue psychotropic drugs and provide evaluation need to be in place to minimize gaps in treatment. Standing orders for the administration of psychotropic medications are considered inappropriate.
      • The Medical Director should be a licensed health care professional who supervises the medical care and ensures that written protocols are maintained and periodically revised.
      • Medical personnel must report to an authority other than the penal system, such as the public health department, while remaining integrated within the operations of the detention facility and juvenile court system.
      • Health care professionals caring for detained youth within a detention facility should not participate in police or punishment processes, including evidence collection (

        National Commission on Correctional Health Care Standards for Health Services in Juvenile Confinement Facilities. Chicago, IL: National Commission on Correctional Health Care, August 1984.

        ).
      • Health care providers should regularly evaluate the medical safety of detainees’ activities, including exercise regimens during hot weather, conditioning, aquatics, and the safety of climbing equipment. In addition, the appropriateness and types of physical restraints employed as well as the use of physical force should routinely be examined.
      • A formal program of health education, especially in long-term facilities, should be offered to detained youth (

        National Commission on Correctional Health Care Standards for Health Services in Juvenile Confinement Facilities. Chicago, IL: National Commission on Correctional Health Care, August 1984.

        ).
      • Health care professionals, child advocacy groups, and other youth-related organizations must demand accountability from detention authorities to ensure the health and well-being of juvenile detainees. (

        Widom R, Hammett TM. Research in brief: HIV/AIDS and STDs in juvenile facilities. Washington, DC: U.S. Department of Justice, Office of Justice Programs, National Institute of Justice. April 1996:1–11.

        )

      References

        • Costello J.C.
        • Jameson E.J.
        Legal and ethical duties of health care professionals to incarcerated children.
        J Legal Med. 1987; 8: 191-263
      1. Poe-Yamagata E. Detention and delinquency cases, 1985–1994. Office of Juvenile Justice and Delinquency Prevention fact sheet No. 56. March 1997. U.S. Department of Justice, Washington, DC.

      2. Austin J, Krisberg B, DeComo R. Juveniles taken into custody: Fiscal Year 1993. Office of Juvenile Justice and Delinquency Prevention. U.S. Department of Justice. Washington, DC; 1995:63.

        • Langan P.A.
        America’s soaring prison population.
        Science. 1991; 251: 1568-1573
      3. Common Health Problems of Juveniles in Correctional Facilities. Chicago, IL: American Medical Association, 1979.

      4. Council on Scientific Affairs. Health status of detained and incarcerated youths. JAMA 1990;263:987–91.

        • Schneider J.
        The relationship between physical and sexual abuse and tobacco, alcohol, and illicit drug use among youths in a juvenile detention center.
        Int J Addict. 1988; 23: 351-378
      5. Survey of Youth in Custody, 1987. Special Report. Washington, DC: Bureau of Justice Statistics, 1988.

        • Jessor R.
        Risk behavior in adolescence.
        J Adolesc Health. 1991; 12: 597-605
        • Morris R.E.
        Health risk behavior survey from thirty-nine juvenile correctional facilities in the United States.
        J Adolesc Health. 1995; 17: 334-344
        • Litt I.F.
        • Cohen M.I.
        Prison, adolescents, and the right to quality medical care.
        Am J Public Health. 1974; 64: 239-245
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        • Cohen M.I.
        • Litt I.F.
        • et al.
        Juvenile detention.
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        • Farrow J.A.
        • Stamm W.E.
        • et al.
        Sexually transmitted diseases in females in a juvenile detention center.
        Sex Transm Dis. 1985; 12: 140-144
      6. Statistical Abstract of the United States. The national data book. October 1997. Bureau of the Census, U.S. Department of Commerce, Economics, and Statistics Administration, 1997:209.

        • Morris R.E.
        • Anderson M.
        • Baker C.J.
        Health care for incarcerated adolescents.
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      7. Committee on Adolescence. Health care for children and adolescents in detention centers, jails, lock-ups, and other court-sponsored residential facilities. Pediatrics 1989;84:118–20.

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        Medical responsibility to incarcerated children.
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        • Lampkin A.
        • Lorish C.D.
        Medical status of adolescents at time of admission to a juvenile detention center.
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        • Trupin E.
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        Incarcerated youths.
        Pediatrics. 1985; 75: 539-540
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        • Turner F.D.
        Characteristics of incarcerated delinquents.
        J Am Acad Child Psychiatry. 1985; 24: 221-226
        • Lewis D.O.
        • Shanok S.S.
        • Pincus J.H.
        • Glaser G.H.
        Violent juvenile delinquents.
        J Am Acad Child Psychiatry. 1979; 18: 307-319
        • Lewis D.O.
        • Feldman M.
        • Barrengos A.
        Race, health, and delinquency.
        J Am Acad Child Psychiatry. 1985; 24: 161-167
        • Kashani J.H.
        • Manning G.W.
        • McKnew D.H.
        Depression among incarcerated delinquents.
        Psychiatry Res. 1980; 3: 185-191
        • Woolf A.
        • Funk S.G.
        Epidemiology of trauma in a population of incarcerated youth.
        Pediatrics. 1985; 75: 463-468
      8. Widom R, Hammett TM. Research in brief: HIV/AIDS and STDs in juvenile facilities. Washington, DC: U.S. Department of Justice, Office of Justice Programs, National Institute of Justice. April 1996:1–11.

      9. National Commission on Correctional Health Care Standards for Health Services in Juvenile Confinement Facilities. Chicago, IL: National Commission on Correctional Health Care, August 1984.